Provider Demographics
NPI:1598862542
Name:SLOAN, LUKE B (MD)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:B
Last Name:SLOAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 11TH ST
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1578
Mailing Address - Country:US
Mailing Address - Phone:541-386-2517
Mailing Address - Fax:541-386-1919
Practice Address - Street 1:917 11TH ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1578
Practice Address - Country:US
Practice Address - Phone:541-386-2517
Practice Address - Fax:541-386-1919
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22481207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR879128001OtherBLUE CROSS BLUE SHIELD
1018614OtherCHPW/WA DSHS
070015619OtherRAILROAD MEDICARE
ORF81003Medicare UPIN
1018614OtherCHPW/WA DSHS